Folliculitis might be associated with pathergy-positivity in patients with Behçet syndrome.

Pathergy test indicates nonspecific hyper-reactivity of the skin to aseptic trauma in Behçet syndrome (BS) and is considered as an adjunctive diagnostic test with a good specificity albeit with low sensitivity. We tested the hypothesis that a relationship exists between active clinical manifestations of BS and the pathergy-positivity when performed simultaneously. Pathergy test and detailed dermatologic examination were done in 105 BS patients (60M/45F); who were seen consecutively at the multi-disciplinary BS outpatient clinic in a single tertiary center. Information regarding demographic and clinical characteristics, pathergy test results at diagnosis, and details about treatment were obtained from patient charts. Disease activity was assessed using Behçet Disease Current Activity Form. Among 105 patients, 27 (25.7%) were pathergy-positive at the time of the study visit whereas 40.9% were pathergy-positive at the time of the diagnosis. There was no relation between pathergy test and patient age or disease duration, either. Pathergy-positivity was significantly more common in patients with folliculitis compared to those without folliculitis (40.7% vs 19.2%; P = .026). The test was also positive in all 3 patients with leg ulcers due to venous stasis. We found that among all skin-mucosa lesions only the presence of folliculitis was associated with pathergy positivity with statistical significance. It was also remarkable that the current pathergy was positive in all 3 patients with active leg ulcers but this finding warrants further studies because of the low patient numbers.

Kyrle disease: a case report and literature review.

BACKGROUND: Perforating dermatoses are heterogeneous skin disorders characterized by transepidermal elimination of dermal tissue components. Acquired perforating dermatoses can be divided into four types, according to the eliminated dermal materials: Kyrle disease, perforating reactive collagenosis, elastosis perforans serpiginosa, and perforating folliculitis. They characterize adult patients with coexisting systemic diseases, regardless of the dermal materials eliminated. The association between Kyrle disease and renal failure or diabetes mellitus is common. CASE REPORT: We reported the case of Kyrle disease in a patient with chronic kidney disease. A literature review was performed with the aim to highlight the associated comorbidities and point out the role of early and specific treatment of the cutaneous symptoms and manifestations. CONCLUSIONS: Being Kyrle disease a pruritic condition which adversely affects the patient's quality of life, it would be desirable to place greater therapeutic attention on the alleviation of itching and on the correct management of the underlying comorbidity.

EGFR inhibitor-induced folliculitis decalvans: a case series and management guidelines.

Epidermal growth factor receptor (EGFR) is one of therapeutic targets in oncology for solid tumors originating from epithelial tissue, such as non-small-cell lung carcinoma (NSCLC) and breast cancer. EGFR inhibitors used in cancer treatment may cause a broad spectrum of dose-dependent cutaneous adverse events, including acneiform papulopustular rash, nail and hair disturbances, xerosis, and mucositis. The pathogenesis of the EGFR inhibitor-induced adverse reactions originates from disturbances in keratinocyte differentiation, cytokine secretion, and neutrophil chemotaxis. One of the rare, yet distressing adverse events may be folliculitis decalvans, a progressive neutrophil-driven scarring alopecia with hair tufts formation resembling doll's hair. Early diagnosis and introduction of treatment are crucial for disease prognosis since a long course of the disease leads to decreased quality of life. Here, we review the literature cases of EGFR inhibitor-induced folliculitis decalvans and provide guidance on management and prevention of this condition in oncologic patients. Furthermore, we report the first afatinib-associated folliculitis decalvans in three female patients with NSCLC.

Drug Survival of Oral Retinoids in Hidradenitis Suppurativa: A Real-Life Cohort Study.

INTRODUCTION: Cohort studies on the use of retinoids for hidradenitis suppurativa (HS) have yielded contradicting results. As the clinical presentation of HS is heterogeneous, with different predilection sites and hallmark features, it can be hypothesized that HS phenotypes are associated with the effectiveness of specific retinoid treatments. OBJECTIVES: The aim of this study was to evaluate the drug survival of oral retinoids in the treatment of HS and to establish predictors for longer treatment duration. METHODS: A retrospective, dual-center study was conducted in the Netherlands in adult HS patients treated with oral retinoids between 2011 and 2021. Drug survival analyses were performed through Kaplan-Meier survival curves. Additionally, Cox regression models were used to determine predictors for a longer drug survival. RESULTS: In total, 102 patients were included. Overall drug survival of (low-dose) isotretinoin (n = 66) at 12 and 24 months was 44.2% and 15.5%, respectively. Termination of treatment was mostly due to ineffectiveness (26%). Presence of widespread comedones (p = 0.03) and the use of concomitant systemic medication (p = 0.04) were associated with a prolonged treatment duration. For acitretin (n = 36), the overall drug survival was 42.0% at 12 months and 37.4% at 24 months, and was also predominantly determined by ineffectiveness (28%). Interestingly, the scarring folliculitis phenotype (p < 0.05) was associated with prolonged drug survival time for acitretin treatment relative to the regular phenotype. CONCLUSION: Comparable drug survival rates at 12 months for isotretinoin and acitretin were found. HS patients with widespread comedones and the scarring folliculitis phenotype could benefit from treatment with isotretinoin or acitretin, respectively.

Folliculitis decalvans and dystrophic epidermolysis bullosa: a significant association.

This work reports 30 cases of folliculitis decalvans (FD) in patients with dystrophic epidermolysis bullosa (DEB) among a cohort of 125 DEB patients seen between 2010 and 2021 in 2 French expert centers for the management of inherited epidermolysis bullosa. Such an association between two rare diseases cannot be fortuitous and implies a physiopathological link that we discuss in this paper. This association is a new significant fact to add to the reflexion on FD causes, suggesting that skin abnormality of DEB could act as a factor of a specific skin barrier alteration which could favor FD. Scarring alopecia with tufted folliculitis and pustules on inflamed skin at the vertex of a woman with dominant dystrophic epidermolysis bullosa.

Patología infecciosa del vestíbulo nasal / Infectious diseases of the nasal vestibule

El vestíbulo nasal corresponde a la primera porción de la fosa nasal, éste se encuentra delimitado lateralmente por los cartílagos alares y medialmente por el borde caudal del septum nasal y la columela. Las enfermedades infecciosas del vestíbulo nasal son patologías frecuentes en la práctica clínica; su diagnóstico se realiza en base a sospecha clínica y examen físico, requiriendo habitualmente solo manejo médico ambulatorio. Desde el punto de vista etiológico pueden ser virales, bacterianas y fúngicas. Las principales especies bacterianas involucradas corresponden a Staphylococcus coagulasa negativa, S. epidermidis, S. hominis y S. haemolyticus, difteroides spp y S. aureus. Su manejo es esencialmente médico con casos excepcionales requiriendo manejo quirúrgico. En la actualidad existe escasa información epidemiológica al respecto, lo que dificultad la clasificación de los dichos cuadros clínicos. Se realizó una revisión de la literatura sobre cuadros infecciosos que afectan el vestíbulo nasal para lograr sistematizar y clarificar las distintas patologías y sus tratamientos.

The nasal vestibule corresponds to the first portion of the nasal passage, limited laterally by the lateral crus and medially by the caudal edge of the nasal septum and columella. Infectious diseases of the nasal vestibule are frequent in clinical practice, diagnosis is made based on clinical suspicion and physical examination, usually requiring only ambulatory medical management. In terms of etiology, they can be viral, bacterial and fungal. The main bacterial species involved correspond: Coagulase-negative Staphylococcus, S. epidermidis, S. hominis and S. haemolyticus, difteroides spp and S. aureus. Management is essentially medical and only exceptionally requires surgery. Currently, there is a lack of epidemiological information in this regard, which makes it difficult to classify these clinical conditions. A review of the literature on infectious conditions that affect the nasal vestibule was performed, to systematize and clarify the different pathologies and their management.

Folliculitis decalvans and lichen planopilaris phenotypic spectrum: a case series of biphasic clinical presentation and theories on pathogenesis.

We present a series of 13 patients with clinical and histological features of both folliculitis decalvans (FD) and lichen planopilaris (LPP), either concomitantly, or sequentially as the clinical phenotype changed over time. This biphasic presentation of FD-LPP is not as uncommon as would be expected from the lack of description in the literature. We discuss current theories about the pathogenesis of both LPP and FD, and speculate how abnormal immune responses may either predispose to secondary bacterial infection or be influenced by dysbiosis of the skin/hair follicle microbiome, resulting in inflammation and permanent hair follicle damage.

Resolution of folliculitis decalvans with medical honey.

Folliculitis decalvans is a rare scarring alopecia that presents with indurated, tender pustules and papules on the vertex and occipital scalp. Although systemic antibiotics with activity against Staphylococcus species provide some symptomatic improvement, folliculitis decalvans remains a significant management challenge and often exhibits a relapsing-and-remitting course. In this report, we posit the potential utility of medical grade honey as a safe and cost-effective adjuvant therapy in the treatment of folliculitis decalvans. We describe a patient with painful, boggy scalp pustules who achieved clearance of his scalp lesions with the addition of Manuka honey. To our knowledge, this report is the first to demonstrate the clinical use of honey in the management of folliculitis decalvans and may lend support to the role of Staphylococcus in the pathogenesis of this disease.

Etiology of Fournier gangrene as a prognostic factor in mortality: Analysis of 121 cases. / Etiología de la gangrena de Fournier como factor pronóstico de mortalidad: análisis de 121 casos.

OBJECTIVE: Evaluate the origin of Fournier gangrene (FG) as a prognostic factor of morbidity and mortality. MATERIAL AND METHODS: Patients who came to our clinic with a diagnosis of FG from 2010 to 2017 were included retrospectively. Patients were categorized depending on the origin of the infection. Three severity factors were determined in each group: days of hospital stay, the FG severity index, and mortality. Logistic regression test was performed to analyze the data. RESULTS: Of the 130 patients evaluated, the origin was established in 121 based on the clinical history and radiological and surgical findings. Thirty-five patients had an intestinal origin with a mortality of 20.68%, 46 patients had a testicular origin with a mortality of 2.22%, 12 patients had a urinary origin with a mortality of 0%, and 28 patients with a cutaneous origin with a mortality of 16.6%. The testicular origin was the most frequent (38%) in addition to presenting a lower hospital stay, a lower FG severity index, and a lower mortality than those with an intestinal origin (P=.022). CONCLUSIONS: The origin of the infection has a significant prognostic value in the mortality of the patient.

Metastatic squamous cell carcinoma arising in the setting of folliculitis decalvans.

Squamous cell carcinomas (SCCs) often arise secondary to UV-induced DNA damage resulting in genetic mutations, but can also occur in the setting of prolonged inflammation. Folliculitis decalvans (FD) is a rare cicatricial alopecia with a complex, multifactorial pathogenesis that results in chronic inflammation and scarring. We present a patient with severe, chronic FD who developed metastatic squamous cell carcinoma of the scalp.

Folliculitis decalvans: Effectiveness of therapies and prognostic factors in a multicenter series of 60 patients with long-term follow-up.

BACKGROUND: Folliculitis decalvans (FD) is a rare neutrophilic cicatricial alopecia that poses a therapeutic challenge. OBJECTIVES: To describe the therapeutic response in a large number of cases of FD with long-term follow-up and analyze potential prognostic factors associated with severity of form and with a better therapeutic response. METHODS: This multicenter prospective study included patients with FD who had a minimum of 5 years of follow-up. Severity was assessed by the maximum diameter of the cicatricial area. Therapeutic response was evaluated according to stabilization of the size of the cicatricial areas and the improvement in clinical symptoms. RESULTS: A total of 60 patients (37 men [61.7%] and 23 women [38.3%]) with a mean age of 40 years were included. Earlier age of onset (P = .01) was statistically associated with severity of form. Treatment with rifampicin and clindamycin, tetracyclines, and intralesional steroids was the most effective. No statistically significant prognostic factors predicting a better therapeutic response were found. LIMITATIONS: Because FD is a rare disease, the main limitation was the sample size. CONCLUSIONS: An earlier age of onset was associated with the severe form of the disease. The proposed specific therapeutic protocol can be a very useful tool in clinical dermatologic practice.

Hidradenitis Suppurativa, Metabolic Syndrome, and Demodex spp. Infestation.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. This type of dermatosis with underlying chronic inflammation significantly affects the quality of life and may be accompanied by many comorbidities. In this case, Demodex spp. was associated with treatment-resistant and persistent course of skin diseases. A 46-year-old female patient applied to our clinic with complaints of lesions on the body and hip. Her dermatological examination revealed abscess formation and post-inflammatory pigmentation. Millimetric scar formation and improved folliculitis-like lesions were observed on both glutei. These complaints started 7 years ago and become more intense and severe by time. Owing to the diagnoses of diabetes mellitus, hypertension, and hyperlipidemia, the patient was monitored for metabolic syndrome. In the cultures taken from the lesions, no growth was seen. A standardized skin surface biopsy of the patient demonstrated demodicosis. The patient was treated with oral metronidazole and topical permethrin lotion, whereupon a pronounced recovery was observed in her clinical condition. In the light of this case, we recommend that patients with HS should be checked for the presence of Demodex spp., and if it is detected, an appropriate treatment should be applied. To our knowledge, this is the first case report presenting the relationship between HS and Demodex infestation.

Isotretinoin treatment for folliculitis decalvans: a retrospective case-series study.

BACKGROUND: The literature includes only a few reports of oral isotretinoin for the treatment of folliculitis decalvans (FD). This study aimed to determine the most effective dose and duration of oral isotretinoin monotherapy for achieving remission in FD patients. METHODS: This retrospective case series study included FD patients that were treated with oral isotretinoin. Patient demographics, clinical characteristics, and treatment details were obtained from the patients' medical records. Patients were contacted via telephone after treatment was completed and asked about any relapses, time period of relapses, and the long-term effects of the treatment. RESULTS: The study included 39 male patients with a mean age of 37.9 ± 15.5 years. All of the patients received oral isotretinoin 0.1-1.02 mg/kg/day (10-90 mg/day) for a median duration of 2.5 months (range: 1-8 months). In all, 82.0% of patients healed after the treatment. Patients that received oral isotretinoin ≥0.4 mg/kg/day for ≥3 months responded better, and 66% of them never relapsed. CONCLUSION: Contrary to general belief, oral isotretinoin monotherapy resulted in complete response in the majority of patients in this study. Based on this finding, we think oral isotretinoin ≥0.4 mg/kg/day should be given for ≥3 months to minimize the likelihood of relapse. In addition, we think oral isotretinoin monotherapy should be considered a promising treatment alternative for FD that warrants further research.